From today’s New York Times (with apologies for wonky formatting.)
Preparing vaccines in Rochester Hills, Mich. Emily Elconin for The New York Times
The C.D.C. has begun to publish data on Covid outcomes among people who have received booster shots, and the numbers are striking:
Based on 25 U.S. jurisdictions. | Source: C.D.C.
As you can see, vaccination without a booster provides a lot of protection. But a booster takes somebody to a different level.
This data underscores both the power of the Covid vaccines and their biggest weakness — namely, their gradual fading of effectiveness over time, as is also the case with many other vaccines. If you received two Moderna or Pfizer vaccine shots early last year, the official statistics still count you as “fully vaccinated.” In truth, you are only partially vaccinated.
Once you get a booster, your risk of getting severely ill from Covid is tiny. It is quite small even if you are older or have health problems.
The average weekly chance that a boosted person died of Covid was about one in a million during October and November (the most recent available C.D.C. data). Since then, the chances have no doubt been higher, because of the Omicron surge. But they will probably be even lower in coming weeks, because the surge is receding and Omicron is milder than earlier versions of the virus. For now, one in a million per week seems like a reasonable estimate.
That risk is not zero, but it is not far from it. The chance that an average American will die in a car crash this week is significantly higher — about 2.4 per million. So is the average weekly death rate from influenza and pneumonia — about three per million.
With a booster shot, Covid resembles other respiratory illnesses that have been around for years. It can still be nasty. For the elderly and immunocompromised, it can be debilitating, even fatal — much as the flu can be. The Omicron surge has been so terrible because it effectively subjected tens of millions of Americans to a flu all at once.
For the unvaccinated, of course, Covid remains many times worse than the flu.
I’m highlighting these statistics because there is still a large amount of vaccine skepticism in the U.S. I have heard it frequently from readers in the past week, after our poll on Covid attitudes and partisanship, as well as the “Daily” episode about the poll.
This vaccine skepticism takes two main forms. The more damaging form is the one that’s common among Republicans. They’re so skeptical of vaccines — partly from misinformation coming from conservative media figures and Republican politicians — that many remain unvaccinated.
Look at this detail from the Kaiser Family Foundation’s latest portrait of vaccination: Incredibly, there are more unvaccinated Republican adults than boosted Republican adults.
From a survey of 1,536 adults in Jan. 2022. | Source: Kaiser Family Foundation
This lack of vaccination is killing people. “It’s cost the lives of people I know, including just last week a friend of 35 years, a person I met on one of the first weekends of my freshman year of college,” David French, a conservative writer who lives in Tennessee, wrote in The Atlantic. “I can’t tell you how heartbreaking it is to see person after person fall to a virus when a safe and effective shot would have almost certainly not just saved their life but also likely saved them from even having a serious case of the disease.”
Dr. Peter Hotez, a vaccine expert at the Baylor College of Medicine, estimates that in the second half of last year, 200,000 Americans needlessly lost their lives because they refused Covid vaccines. “Three doses of either Pfizer or Moderna will save your life,” Hotez told me. “It’s the only way you can be reasonably assured that you will survive a Covid-19 infection.” (Young children, who are not yet eligible for the vaccines, are also highly unlikely to get very sick.)
The vaccines don’t prevent only death. Local data shows the risks of hospitalization are extremely low, too. Vaccination also reduces the risk of long Covid to very low levels.
Healthy and anxious
The second form of vaccine skepticism is among Democrats — although many would recoil at any suggestion that they are vaccine skeptics. Most Democrats are certainly not skeptical about getting a shot. But many are skeptical that the vaccines protect them.
About 41 percent of Democratic voters say they are worried about getting “seriously sick” with Covid, according to a Kaiser Family Foundation poll released last week. That’s a very high level of anxiety for a tiny risk.
Here’s the proof that much of the fear is irrational: Young Democrats are more worried about getting sick than old Democrats, even though the science says the opposite should be true.
From a survey of 1,536 adults in Jan. 2022. | Source: Kaiser Family Foundation
The most plausible explanation for this pattern is political ideology. Younger Democrats are significantly more liberal than older Democrats, according to the Pew Research Center (and other pollsters, too). Ideology tends to shape Covid views, for a complex mix of often irrational reasons. The more liberal you are, the more worried about Covid you tend to be; the more conservative you are, the less worried you tend to be.
I know that many liberals believe an exaggerated sense of personal Covid risk is actually a good thing, because it pushes the country toward taking more precautions. Those precautions, according to this view, will reduce Covid’s death toll, which truly is horrific right now. In a later newsletter this week, I will consider that argument.
For now, I’ll simply echo the many experts who have pleaded with Americans to get vaccinated and boosted.
Answers and convenience
What might help increase the country’s ranks of vaccinated? Vaccine mandates, for one thing — although many Republican politicians, as well as the Republican appointees on the Supreme Court, oppose broad mandates. Private companies can still impose mandates on their employees and customers.
Without mandates, the best hope for increased vaccination is probably community outreach. While many unvaccinated Americans are firmly opposed to getting a shot, others — including some Democrats and independents — remain agnostic. If getting a vaccination is convenient and a nurse or doctor is available to answer questions, they will consider it.
“I cannot count how many people I’ve spoken to about the Covid vaccine who have been like, ‘No, I don’t think so. No,’” Dr. Kimberly Manning of Emory University told The Atlanta Journal-Constitution. “Then I run into them two weeks later and they tell me they got vaccinated.”
Related: “You have to scratch your head and say, ‘How the heck did this happen?’” Dr. Anthony Fauci told Michael Barbaro on today’s episode of “The Daily,” about the partisan gap in Covid attitudes. Fauci also predicted that people who were anxious about Covid would become less so as caseloads fell.
In Times Opinion, James Martin, a Jesuit priest, argues that schadenfreude over vaccine skeptics’ suffering warps the soul.
Encouraging news from today’s New York Times (Sorry, the formatting is a little wonky):
Why the vaccine news is better than you may think.
By David Leonhardt
Preparing the Pfizer vaccine in Phoenix.Adriana Zehbrauskas for The New York Times
‘We’re underselling the vaccine’ Early in the pandemic, many health experts — in the U.S. and around the world — decided that the public could not be trusted to hear the truth about masks. Instead, the experts spread a misleading message, discouraging the use of masks.
Their motivation was mostly good. It sprung from a concern that people would rush to buy high-grade medical masks, leaving too few for doctors and nurses. The experts were also unsure how much ordinary masks would help.
But the message was still a mistake.
It confused people. (If masks weren’t effective, why did doctors and nurses need them?) It delayed the widespread use of masks (even though there was good reason to believe they could help). And it damaged the credibility of public health experts.
“When people feel as though they may not be getting the full truth from the authorities, snake-oil sellers and price gougers have an easier time,” the sociologist Zeynep Tufekci wrote early last year.
Now a version of the mask story is repeating itself — this time involving the vaccines. Once again, the experts don’t seem to trust the public to hear the full truth.
This issue is important and complex enough that I’m going to make today’s newsletter a bit longer than usual. If you still have questions, don’t hesitate to email me at email@example.com.
‘Ridiculously encouraging’ Right now, public discussion of the vaccines is full of warnings about their limitations: They’re not 100 percent effective. Even vaccinated people may be able to spread the virus. And people shouldn’t change their behavior once they get their shots.
These warnings have a basis in truth, just as it’s true that masks are imperfect. But the sum total of the warnings is misleading, as I heard from multiple doctors and epidemiologists last week.
“It’s driving me a little bit crazy,” Dr. Ashish Jha, dean of the Brown School of Public Health, told me.
“We’re underselling the vaccine,” Dr. Aaron Richterman, an infectious-disease specialist at the University of Pennsylvania, said.
“It’s going to save your life — that’s where the emphasis has to be right now,” Dr. Peter Hotez of the Baylor College of Medicine said.
The Moderna and Pfizer vaccines are “essentially 100 percent effective against serious disease,” Dr. Paul Offit, the director of the Vaccine Education Center at Children’s Hospital of Philadelphia, said. “It’s ridiculously encouraging.”
The details Here’s my best attempt at summarizing what we know:
The Moderna and Pfizer vaccines — the only two approved in the U.S. — are among the best vaccines ever created, with effectiveness rates of about 95 percent after two doses. That’s on par with the vaccines for chickenpox and measles. And a vaccine doesn’t even need to be so effective to reduce cases sharply and crush a pandemic.
If anything, the 95 percent number understates the effectiveness, because it counts anyone who came down with a mild case of Covid-19 as a failure. But turning Covid into a typical flu — as the vaccines evidently did for most of the remaining 5 percent — is actually a success. Of the 32,000 people who received the Moderna or Pfizer vaccine in a research trial, do you want to guess how many contracted a severe Covid case? One.
Although no rigorous study has yet analyzed whether vaccinated people can spread the virus, it would be surprising if they did. “If there is an example of a vaccine in widespread clinical use that has this selective effect — prevents disease but not infection — I can’t think of one!” Dr. Paul Sax of Harvard has written in The New England Journal of Medicine. (And, no, exclamation points are not common in medical journals.)
On Twitter, Dr. Monica Gandhi of the University of California, San Francisco, argued: “Please be assured that YOU ARE SAFE after vaccine from what matters — disease and spreading.”
The risks for vaccinated people are still not zero, because almost nothing in the real world is zero risk. A tiny percentage of people may have allergic reactions. And I’ll be eager to see what the studies on post-vaccination spread eventually show. But the evidence so far suggests that the vaccines are akin to a cure
Offit told me we should be greeting them with the same enthusiasm that greeted the polio vaccine: “It should be this rallying cry.”
The costs of negativity Why are many experts conveying a more negative message?
Again, their motivations are mostly good. As academic researchers, they are instinctively cautious, prone to emphasizing any uncertainty. Many may also be nervous that vaccinated people will stop wearing masks and social distancing, which in turn could cause unvaccinated people to stop as well. If that happens, deaths would soar even higher.
But the best way to persuade people to behave safely usually involves telling them the truth. “Not being completely open because you want to achieve some sort of behavioral public health goal — people will see through that eventually,” Richterman said. The current approach also feeds anti-vaccine skepticism and conspiracy theories.
After asking Richterman and others what a better public message might sound like, I was left thinking about something like this:
We should immediately be more aggressive about mask-wearing and social distancing because of the new virus variants. We should vaccinate people as rapidly as possible — which will require approving other Covid vaccines when the data justifies it.
People who have received both of their vaccine shots, and have waited until they take effect, will be able to do things that unvaccinated people cannot — like having meals together and hugging their grandchildren. But until the pandemic is defeated, all Americans should wear masks in public, help unvaccinated people stay safe and contribute to a shared national project of saving every possible life.
Sharing a wonderful piece by NY Times culture writer Amanda Hess, about how incredibly annoying it is to see celebrity “news” about how hard it is for them to cope with the current crisis by sheltering in place in their ginormous houses.
Aw, boo-freakin’-hoo. Was there ever a time that celebrities were less relevant?!?
Amid concerns about the spread of COVID-19, here’s a practical and uplifting guide to managing our anxieties.
As the author writes in today’s New York Times, the good news is that “even in the face of fear, we do have the capacity to act in ways that would help limit contagion during an epidemic. (If link doesn’t work, here is the article.)
Are you fearful about catching the coronavirus? Are you anxious about whether you’re properly prepared for its arrival? You’re in good company.
In the past few days, I’ve had more than a few patients call or email to ask me to double or even triple the dosage of their prescription antidepressant or anti-anxiety medication so that they could have a bigger supply on hand “just in case.”
Throughout the country, people are stockpiling food in anticipation of a shortage or a quarantine. Supplies of Purell hand sanitizer flew off the shelves in local pharmacies and are now hard to find or even unavailable online.
I understand the impulse to secure one’s safety in the face of a threat. But the fact is that if I increase the supply of medication for my patients, I could well deprive other patients of needed medication, so I reluctantly declined those requests.
As a psychiatrist, I frequently tell my patients that their anxieties and fears are out of proportion to reality, something that is often true and comforting for them to realize. But when the object of fear is a looming pandemic, all bets are off.
In this case, there is reason for alarm. The coronavirus is an uncertain and unpredictable danger. This really grabs our attention, because we have been hard-wired by evolution to respond aggressively to new threats. After all, it’s safer to overact to the unknown than to do too little.
Unfortunately, that means we tend to overestimate the risk of novel dangers. I can cite you statistics until I am blue in the face demonstrating that your risk of dying from the coronavirus is minuscule compared with your risk of dying from everyday threats, but I doubt you’ll be reassured. For example, 169,000 Americans died by accident and 648,000 died of heart disease in 2017, according to the Centers for Disease Control and Prevention. As of Sunday morning 19 Americans had died from the coronavirus.
The reason this probably doesn’t make you feel better is simple: Just as we tend to assume the worst about novel threats — the safest, if not the most statistically justifiable, strategy — we tend to underestimate the danger of familiar risks because we are habituated to them. We are not very rational when it comes to assessing risk.
The good news is that even in the face of fear, we do have the capacity to act in ways that would help limit contagion during an epidemic. Specifically, we can behave altruistically, which benefits everyone.
For example, research shows that when people are told that it is possible — but not certain — that going to work while sick would infect a co-worker, people are less willing to stay home than when they are reminded of the certainty that going to work sick would expose vulnerable co-workers to a serious chance of illness. Stressing the certainty of risk, in other words, more effectively motivates altruism than stressing the possibility of harm.
The lesson for the real world is that health officials should be explicit in telling the public that selfish responses to an epidemic, such as going to work while sick or failing to wash your hands, threaten the health of the community.
There are other ways to encourage selfless behavior. For example, another study examined the neural activity of people while they played a game in which they made either generous or selfish choices to award or withhold money. The researchers found that when subjects made selfish decisions, the brain’s reward center was activated, whereas when they made generous decisions, a region of the brain implicated in empathy lit up. This suggests that people are more likely to be altruistic if they are primed to think of others and to imagine how their behavior might benefit them.
There is no question that we can all be encouraged to act in the interest of our fellow humans during perilous times. Specifically, public figures need to convey loudly and clearly that we should not go to work or travel when we’re sick and that we should not hoard food and medical supplies beyond our current need — not just give us health statistics or advise about how to wash our hands.
But that will require morally authoritative leaders who can inspire the better angels of our nature by reminding us that we are all in this epidemic together.
Richard A. Friedman is a professor of clinical psychiatry and the director of the psychopharmacology clinic at the Weill Cornell Medical College, and a contributing opinion writer.